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Medicaid News
New York State Gets $1.5 Billion from Feds to Change
Medicaid Program
New Medicaid programs bumping along as states
implement change
 October 3, 2006 Medicaid, for most people, is
somewhere below the radar. For senior citizens, many already at the
poverty level and many more who seeing poverty as a possibility as
healthcare costs eat away modest savings, Medicaid is a "god-send." This
program that provides healthcare for those in need, however, is going
through massive change to meet new federal mandates. And the feds are
serious Health and Human Services has agreed to pay New York state
$1.5 billion to make reforms. The daily report by KaiserNet.org looks at
how things are changing in other states, too.
 New
York State to Get $1.5 Billion from HHS
HHS has agreed to pay New
York $1.5 billion over five years to help stabilize the state's hospital
industry in exchange for renewed efforts to shrink the industry, curb
Medicaid costs and reduce Medicaid fraud, the
New York Times reports.
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Related Stories |
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Patients Key to Latest Medicaid Reforms as States
Roll Out Money-Saving Plans
'Healthier beneficiaries are cheaper than sicklier
ones' is the theme
By Daniel C. Vock, Stateline.org Staff Writer
October
3, 2006 - Medicaid reform is arriving with a splash in
Jacksonville and Ft. Lauderdale, Fla. Its being plugged in radio
commercials, touted on billboards and talked up with church groups. All
of the hype aims to prep recipients so that, from the moment they
receive a bright lime-green and blue envelope in the mail, they feel
theyre joining the cause.
Read more...
Former HHS Secretary Wants Feds to Take Over
Medicaid for Elderly
Some say he may have financial benefit it the idea
catches on
August 8, 2006 The former secretary of Health &
Human Services, Tommy Thompson, has proposed that the long-term care of
the elderly in Medicaid by managed by the federal government, without
participation of the states, which should focus on those under age 65.
Today's KaiserNet.org daily report says, however, that Thompson could
have a financial benefit in this plan. This is just one of today's
stories in the report on health care.
Read more...
States Offered $1.75 Billion by HHS to Help
Medicaid Patients Live at Home
People who need care and prefer to live
in their own homes can do so
July 26, 2006 - Health and Human Services announced
today it will offer $1.75 billion over five years to states who help
shift Medicaid patients from institutions to home and community-based
services. Read more...
Bush Administration Exempts Millions in Medicaid
from Proof of Citizenship
July 7, 2006 Facing lawsuits and unhappy state
health officials, the Bush administration has backed off at least a
little on the requirement that took effect on July 1 that Medicaid
applicants provide proof of citizenship. In an announcement yesterday,
the Centers for Medicare and Medicaid said certain beneficiaries will be
exempted. It is estimated to include about eight million of the 55
million Medicaid users.
Read more...
Read more
Medicaid News |
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The "logic behind the deal ... is that smart
investments will allow the state to reduce the cost of New York's
Medicaid program," according to state officials, the Times reports. No
other state had negotiated a similar agreement with HHS.
According to the Times, New York hospitals "have
been in crisis for several years," with about 20 closing their doors
during the last five years, several others filing for bankruptcy and
many others in "precarious condition." The agreement, negotiated over 16
months, contains many specific requirements that the state must meet in
order to receive the entire $1.5 billion.
The requirements include:
● Meeting targets for reducing the use of
hospitals and increasing the use of Medicaid managed care plans;
● Limiting access to certain drugs for Medicaid
beneficiaries; and
● Substantially increasing the amount of money
the state recovers from Medicaid fraud cases, from about $215 million in
the second year of the agreement to $644 million in the fifth year.
The fraud targets are "much higher than the amount
any state has recovered to date" -- until last year, no state had
collected more than $100 million in a single year, the Times reports.
Officials said that if the state does not meet the fraud recovery goals,
it will forfeit up to $500 million.
Failure to meet other requirements might jeopardize
the entire $1.5 billion, "but those standards are likely to be easier to
meet," according to the Times.
A separate part of the agreement is intended to
decrease use of nursing homes, although federal funding is not tied to
that provision. A state commission created by New York Gov. George
Pataki (R) and the state legislature plans to release a report including
recommendations for reforming the hospital system on Dec. 1.
Reaction
Hospital executives and lawmakers said that "without the infusion of
federal money, it would be hard to carry out the commission's
recommendations," the Times reports.
Michael Marr, a spokesperson for Pataki, said,
"This agreement is a tremendous win for New Yorkers," adding that the
deal helps ensure that the state hospital industry "remains strong,
efficient and sustainable for many years to come" (Perez-Pena, New York
Times, 10/3).
Kaiser Daily Health Policy Report Highlights
Recent State Medicaid Developments
Several newspapers recently reported on state
Medicaid program developments. Summaries appear below.
● Florida: Twenty-three percent of those
in a Medicaid pilot project that allows beneficiaries to seek
alternative therapies for chronic pain -- including massage therapy,
acupuncture and meditation -- have reported improvement in their
physical condition, the
St. Petersburg Times reports.
The project reduced average monthly Medicaid
spending for beneficiaries with chronic pain -- averaging $920 per month
prior to enrollment for doctor and hospital visits and prescription
drugs -- by $105 per beneficiary. However, the program costs the state
$103 per person per month.
Funding for the pilot project ends in January 2007,
and it is unclear whether the state Legislature will eliminate the
program or expand it. Krista Moody, a spokesperson for
Florida's Agency for Health Care
Administration, said the administration wants another cost
study before making a recommendation (Nohlgren, St. Petersburg Times,
10/2).
● Georgia: Nearly 70,000 Georgia Medicaid
beneficiaries, or 5.3%, lost benefits between Jan. 1 and April after the
state enacted rules designed to discourage fraud, the
Atlanta Journal-Constitution
reports.
The new eligibility rules require Medicaid
beneficiaries to provide proof of income and citizenship, such as a W-2
or income tax return form and a birth certificate or U.S. passport.
Between January and April, when the latest
statistics were released, 69,635 people were dropped from the state
program, including 50,000 children and 10,000 people who evacuated prior
to Hurricane Katrina and did not to renew their benefits. The state also
eliminated benefits for 2,827 undocumented immigrants, including
emergency medical care, dialysis for children and prenatal care for
women with high-risk pregnancies.
State officials say the enrollment decline was
partially due to an increase in income levels of some beneficiaries.
Medicaid officials also said the new rules comply with federal
standards, and some of the children dropped from the program switched to
a new type of coverage, including PeachCare for Kids.
Consumer advocates criticized the new requirements,
saying they will not be effective in preventing fraud and will prevent
U.S.-born citizens from obtaining benefits (Miller, Atlanta
Journal-Constitution, 9/30).
● Mississippi: Mississippi Medicaid
officials have requested a $569.7 million budget for fiscal year 2007,
the same amount expected to be spent this year on the program, the
Jackson Clarion-Ledger
reports.
Last year, about 50,000 people lost Medicaid
coverage after missing face-to-face meetings required by the state
program to check financial qualifications. Recertification for the
program previously was completed by mail, and this past year was the
first time Medicaid required beneficiaries to meeting in person with
officials to verify their financial qualifications.
The decreased enrollment and limits on
prescriptions, also enacted in 2005, reduced spending by $150 million,
Medicaid Executive Director Bob Robinson told lawmakers last week.
However, state House Public Health and Human
Services Committee Chair Steve Holland (D) said the process leaves too
many residents uninsured. According to the Clarion-Ledger, "the
recertification process ... could be revisited in January" (Hipp,
Jackson Clarion-Ledger, 9/29).
● Tennessee: Emergency department visits
by uninsured Tennessee residents increased by 24.9% in the first quarter
of 2006, compared with the same period last year, according to the
Tennessee Hospital Association,
the
Tennessean reports.
Billing reports also show a 67.5% increase in the
cost of providing ED services and an 89.3% increase in the cost of
treating uninsured patients admitted to hospitals.
State officials say that hospitals likely will
shift some of the higher costs to paying hospital customers and that the
increase could result in higher medical insurance premiums. Some
hospital officials have said the increased costs are the result of
changes to the state's expanded Medicaid program,
TennCare.
Last year, 170,000 residents lost coverage under
the program. However, THA President Craig Becker said, "We really don't
know how much is caused by TennCare and how much is caused by commercial
insurers," who are shifting more employees into health plans with higher
deductibles and copayments.
Becker said TennCare enrollment reductions
highlight the need to increase state funding to hospitals that provide
care for low-income residents.
Federal funding to such hospitals was eliminated in
the 1990s as part of a condition of expanding TennCare, but now that the
program is similar to Medicaid programs in other states, "hospitals want
the money back," the Tennessean reports. Matt Leigh, a spokesperson for
U.S. Senate Majority Leader Bill Frist (R-Tenn.), said the senator is
working "to address this difficult matter before the end of the year"
(Pack, Tennessean, 10/2).
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